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Original Articles: Cardiovascular

Subcoronary Allograft Aortic Valve Replacement: Parametric Risk-Hazard Outcome Analysis to a Minimum of 20 Years

^a Wessex Cardiothoracic Centre, Southampton, United Kingdom
^b The Hospital for Sick Children, Toronto, Ontario, Canada

Accepted for publication February 20, 2007.

^_* Address correspondence to Dr Hickey, The Congenital Heart Surgeons’ Society, The Hospital for Sick Children, Room 4431, 555 University Ave, Toronto, Ontario, M6R 1T3, Canada (Email: edward.hickey{at}sickkids.ca).

Background: Differences in sterilization, preservation, and implantation have been implicated in aortic allograft longevity. We report follow-up to 30 years of patients from a single unit who underwent aortic valve replacement with aortic allografts sterilized in antibiotics and refrigerated at 4°C.

Methods: Two hundred consecutive patients underwent subcoronary allograft aortic valve replacement and have been followed up to a minimum of 20 and maximum of 30 years. Follow-up was 96% complete. Parametric hazard phase modeling was used to identify incremental predictors of time-related risk.

Results: Early mortality was 1.5%. Kaplan–Meier actuarial survival, including early death, was 81.2% ± 2.8% (mean ± standard error of the mean), 58.0% ± 3.7%, and 52% ± 5.1% at 10, 20, and 25 years, respectively. Freedom from reoperation for any reason was 86.4% ± 2.6%, 39.6% ± 5.2%, and 35.0% ± 5.4% at 10, 20, and 25 years, respectively. Larger implanted valve, reexploration for bleeding, previous cardiac surgery, and operative rank were independent risks for reoperation. Early mortality in reoperations was 5.1%. Allograft endocarditis has occurred in 6 patients, giving an overall freedom of 94% at 25 years. Seven patients of the original cohort are known to be alive with their original allograft valve in situ, and of these the longest follow-up period is 29.8 years.

Conclusions: The use of antibiotic-sterilized allografts for subcoronary aortic valve replacement confers low operative mortality and excellent long-term survival with durability matching any other nonmechanical device. Significantly reduced time-related risk of reoperation and excellent internal to external diameter ratio renders allograft aortic valve replacement especially ideal for smaller roots.

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